D2.71 - Comprehensive approach to severe bronchial asthma: a case study and the role of biologic therapy
Case report
Severe bronchial asthma (SBA) is a complex, heterogeneous disease affecting approximately 3–10% of individuals with asthma. Despite its small percentage, SBA imposes a significant burden on healthcare systems due to frequent exacerbations, hospitalizations, and reduced quality of life. Biologic therapies, particularly targeting thymic stromal lymphopoietin (TSLP), offer promising advancements in the treatment of SBA, especially in patients with persistent type 2 inflammation.
Case Presentation:
We present the case of a 62-year-old female with a 28-year history of asthma, who previously worked as a surgical nurse. She reported persistent dyspnea, wheezing, and frequent exacerbations requiring systemic corticosteroids despite adherence to maximal inhaled therapy (ICS/LABA/LAMA) and leukotriene receptor antagonists. Comorbidities included chronic obstructive pulmonary disease (COPD), stage 3 arterial hypertension, stage 3 heart failure, and type 2 diabetes mellitus. Despite adherence to maximal inhaled therapy (ICS/LABA/LAMA), leukotriene receptor antagonists and systemic corticosteroids she exhibited uncontrolled symptoms (Asthma Control Test (ACT) score = 12) and required emergency care multiple times in the past week. Spirometry revealed severe airflow limitation (FEV1 = 16%), and elevated total IgE (568 kIU/L) indicated a type 2 inflammatory phenotype. Additional risk factors, including occupational exposure to steroids and prior COVID-19 pneumonia, further complicated disease management. The patient was planned for initiation of TSLP biologic therapy as a precision-based approach for controlling persistent airway inflammation and reducing corticosteroid dependency. Future assessments will focus on treatment response, exacerbation reduction, and lung function improvement.
Conclusion
This case underscores the importance of a structured diagnostic approach in differentiating SBA from other respiratory conditions. Early identification of type 2 inflammation and the strategic use of biologic therapy, particularly TSLP-targeted agents, are crucial in achieving disease control and improving patient outcomes. Personalized treatment strategies remain central to the effective management of severe asthma in complex cases with multiple comorbidities.
